Affidavit of Loss


REPUBLIC OF THE ____________)

__________________ CITY )                          SS.

AFFIDAVIT OF LOSS

I, ____________________________, of legal age, and with address at ___________________________, under oath state:

1. THAT I am a registered owner of SMART Retailer Sim bearing No. _________________;

2. THAT in the afternoon of Saturday, _______________ 20__, my Nokia 3310 containing said SIM was stolen from our store by an unidentified culprit while I was busy conducting an inventory of the goods therein;

4. THAT I exerted due diligence and persistent efforts in locating my aforesaid cellphone and its SIM card but to no avail and I consider the same as lost and can no longer be found;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ___________ at Makati City.

 

______________________

Affiant

SUBSCRIBED AND SWORN to before me this ______________ at Makati City, Affiant exhibiting to me his/her Community Tax Certificate No. ________________ issued on ________________ at ______________.

 

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of______.